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Media Gallery

Blood film (1000× magnification) demonstrating a vacuolated blast in a refractory anemia with excess of blasts in transformation. Courtesy of U. Woermann, MD, Division of Instructional Media, Institute for Medical Education, University of Bern, Switzerland.
This bone marrow film (400× magnification) demonstrates an almost complete replacement of normal hematopoiesis by blasts in a refractory anemia with an excess of blasts in transformation. Note the signs of abnormal maturation such as vacuolation, double nucleus, and macrocytosis. Courtesy of U. Woermann, MD, Division of Instructional Media, Institute for Medical Education, University of Bern, Switzerland.
Bone marrow film (1000× magnification) demonstrating ring sideroblasts in Prussian blue staining in a refractory anemia with excess of blasts in transformation. Courtesy of U. Woermann, MD, Division of Instructional Media, Institute for Medical Education, University of Bern, Switzerland.
Bone marrow film (1000× magnification) demonstrating granular and clotlike positive reaction in periodic acid-Schiff staining in a refractory anemia with excess of blasts in transformation. Courtesy of U. Woermann, MD, Division of Instructional Media, Institute for Medical Education, University of Bern, Switzerland.

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Table 1. Revised International Prognostic Scoring System risk groups and prognosis ^[19]

Risk Group	Time to Development of AML (y)	Median Survival (y)
Very low	NR	8.8
Low	10.8	5.3
Intermediate	3.2	3.0
High	1.4	1.6
Very High	0.7	0.8
AML – Acute myelogenous leukemia

Table 2 Cytogenetic abnormalities assigned an IPSS-R value for scoring

Cytogenetic prognostic subgroups	Cytogenetic abnormalities
Very good	-Y, del(11q)
Good	Normal, del(5q), del(12p), del(20q), double including del(5q)
Intermediate	Del(7q), +8, +19, t(17q), any other single or double independent clones
Poor	-7, inv(3)/t(3q)/del(3q), double including -7,/del(7q), complex: 3 abnormalities
Very poor	Complex: >3 abnormalities

Table 3.Calculation of IPSS-R score

		Points Assigned
		0	0.5	1	1.5	2	3	4
Variable	Cytogenetic subgroup	Very Good		Good		Intermediate	Poor	Very Poor
	Bone marrow blasts (%)	≤2		>2- < 5		5-10	>10
	Hemoglobin (g/dL)	≥10		8-9.9	< 8
	Platelet count (x 10⁹/L)	≥100	50-99.9	< 50
	Absolute neutrophil count (x 10⁹/L)	≥0.8	< 0.8

Table 4. IPSS-R prognostic risk scores and categories

Risk Score	Risk Category
≤1.5	Very Low
>1.5-3	Low
>3-4.5	Intermediate
>4.5-6	High
>6	Very High

Table 5. Clinical outcome by IPSS-R risk category

		IPSS-R Risk Category
		Very Low	Low	Intermediate	High	Very High
Clinical Outcome	Median survival (years)	8.8	5.3	3.0	1.6	0.8
Clinical Outcome	Median time to 25% acute myelogenous leukemia evolution (years)	NR	10.8	3.2	1.4	0.7

Table 6. Categories of FAB classification versus WHO classification for myelodysplastic syndrome (MDS)

FAB Classification	WHO–2004 Classification	WHO–2008 Classification
RA	RA RCMD 5q-	RCUD RCMD 5q-
RARS	RARS RCMD-RS	RARS RCMD-RS RARS-T
RAEB	RAEB-1 RAEB-2	RAEB-1 RAEB-2
CMML	CMML-1 CMML-2	CMML-1 CMML-2
RAEB-T	AML	AML

Table. 2008 and 2016 World Health Organization (WHO) classifications of myelodysplastic syndromes

2008 WHO Classification^[17]	2016 WHO Classification^[50]
Refractory cytopenia with unilineage dysplasia (RCUD) encompassing refractory anemia (RA), refractory neutropenia (RN), and refractory thrombocytopenia (RT)	MDS with single-lineage dysplasia (MDS-SLD)
Refractory cytopenia with multilineage dysplasia (RCMD)	MDS with multilineage dysplasia (MDS-MLD)
Refractory anemia with ringed sideroblasts (RARS)	MDS with ring sideroblasts (MDS-RS) MDS-RS with single lineage dysplasia (MDS-RS-SLD) MDS-RS with multilineage dysplasia (MDS-RS-MLD)
Myelodysplastic syndrome associated with isolated del(5q)	MDS with isolated del(5q)
	MDS with excess blasts (MDS-EB)
Refractory anemia with excess blasts–1 (RAEB-1)	MDS-EB-1
Refractory anemia with excess blasts–2 (RAEB-2)	MDS-EB-2
Myelodysplastic syndrome, unclassified (MDS-U)	MDS, unclassifiable (MDS-U) with 1% blood blasts with single lineage dysplasia and pancytopenia based on defining cytogenetic abnormality
Refractory cytopenia of childhood	Refractory cytopenia of childhood

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